Seasoned Collector, Biller and Professional Coder offering 17 years of expertise in billing, collections, follow up and payment posting while driving continuous improvement by streamlining billing and cash flow processes. Effective in developing best practices to manage aged receivables and optimize collections outreach. Team oriented with the ability to mentor and train staff. Seeking to be an asset to a growing organization while reaching personal career goals.
• Reconciled clinical notes, patient forms and health information for compliance with HIPAA rules.
• Assigned value codes and modifiers to provide specific information for services provided.
• Applied coding rules established by American Medical Association and Centers for Medicare and Medicaid Services for assignment of procedural codes.
• Reviewed clinical data from medical records to assign ICD, CPT and HCPCS codes. Interpreted medical terminology and pharmacological information to translate information into coding system.
• Reviewed clinical documentation for submission and authorizations for Medi-cal, CCS and DHCS.
• Worked closely with clinical trials and research study related accounts for accurate clinical documentation for billing and collections.
• Increased team efficiency by assisting Senior Manager with the implementation of new healthcare software- EPIC during go-live. Nominated as a Super User as the forefront of the Revenue Cycle Department to teach and train staff on Epic healthcare system.
• Investigated billing discrepancies and implemented effective solutions to resolve concerns and prevent future problems.
• Researched and communicated insurance requirements, including patient financial responsibilities and eligibility.
• Billed and submitted insurance claims for Workers Comp, Managed Care, Medi-cal, Medicare and all Commercial payors including submission of provider disputes due to underpayment and or erroneous denials. As well as, prepared and submitted Medicare quarterly report for late charge adjustments.
• Enforced policies and procedures according to compliance with federal and state guidelines.
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